Interferons in vitreoretinal diseases; a review on their clinical application, and mechanism of action.

PURPOSE: This review investigates the therapeutic benefits of interferons (IFNs) in vitreoretinal diseases, focusing on their regulatory roles in innate immunological reactions and angiogenesis. The study aims to categorize the clinical outcomes of IFN applications and proposes a molecular mechanism underlying their action. METHODS: A systematic review was conducted using MEDLINE/PubMed, Web of Science, EMBASE, and Google Scholar databases to identify randomized clinical trials, case series, and case-control studies related to IFNs' impact on vitreoretinal diseases (1990-2022). The data synthesis involved an in-depth analysis of the anti-inflammatory and anti-angiogenesis effects of IFNs across various studies. RESULTS: Our findings indicate that IFNs exhibit efficacy in treating inflammation-associated vitreoretinal disorders. However, a lack of sufficient evidence exists regarding the suitability of IFNs in angiogenesis-associated vitreoretinal diseases like choroidal neovascularization and diabetic retinopathies. The synthesis of data suggests that IFNs may not be optimal for managing advanced stages of angiogenesis-associated disorders. CONCLUSION: While IFNs emerge as promising therapeutic candidates for inflammation-related vitreoretinal diseases, caution is warranted in their application for angiogenesis-associated disorders, especially in advanced stages. Further research is needed to elucidate the nuanced molecular pathways of IFN action, guiding their targeted use in specific vitreoretinal conditions.

Intraocular Pressure Before and After Corneal Refractive Surgery: A Prospective Comparison of Corvis ST and Ocular Response Analyzer.

PRECIS: The study showed that Corvis ST's bIOP and ORA's IOPcc do not agree well, before or after PRK, and may not be used interchangeably. bIOP remained unchanged after PRK. PURPOSE: To evaluate the agreement between the biomechanically-corrected intraocular pressure (bIOP) measured by the Corvis-ST and the cornea-compensated IOP (IOPcc) measured by the Ocular Response Analyzer (ORA) before and after photorefractive keratectomy (PRK). METHODS: In this prospective interventional study, a total of 53 patients (53 eyes) were included. Measurements were acquired using both the Corvis-ST and ORA devices before and 3 months post- PRK. The agreement between the two devices was evaluated using limits of agreement (LoA) and Bland-Altman plots. RESULTS: The participants had a mean age of 29.6±5.21 years (range: 21 to 40), with 41 (77.4%) of them being female. Following the surgery, the average change in IOP was 0.3±1.7 mmHg for bIOP and -1.6±4.0 mmHg for IOPcc. The corresponding 95% LoA were -3.5 to 4.2 mmHg and -9.5 to 6.3 mmHg, respectively. The 95% LoA between bIOP and IOPcc after PRK was -2.3 to 8.5 mmHg. Notably, the bIOP values were higher for IOPs <20 mmHg and lower for IOPs >20 mmHg compared to IOPcc. CONCLUSIONS: The findings indicate a weak agreement between the Corvis ST-bIOP and the ORA- IOPcc both before and after PRK. These devices may not be used interchangeably for IOP measurement. bIOP exhibited less variation compared to the IOPcc, suggesting that the bIOP is a superior option for IOP reading following PRK.

Recent advancements in nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma, review and update.

Despite the existence of numerous eye drops in the market, most of them are not sufficiently effective because of quick clearance and the barriers within the eye. To increase the delivery of the drugs to the eye, various new formulations have been explored in recent decades. These formulations aim to enhance drug retention and penetration, while enabling sustained drug release over extended periods. One such innovative approach is the utilization of contact lenses, which were originally designed for cosmetic purposes and vision correction. Contact lenses have appeared as a promising formulation for ocular drug delivery, as they can increase the bioavailability of drugs in the eye and diminish unwanted side effects. They are specifically appropriate for treating chronic eye conditions, making them an area of interest for researchers in the field of ophthalmology. This review outlines the promising potential of nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma. It classifies therapeutic approaches based on nanomaterial type, summarizes diagnostic advances, discusses improvement of contact lenses properties, covers marketing perspectives, and acknowledges the challenges of these innovative contact lenses for glaucoma management.

Ab-interno Trabeculotomy Procedures: A Review.

Purpose: To discuss the safety and efficacy of various forms of ab-interno trabeculotomy procedures. Methods: A comprehensive search in PubMed and Google Scholar was done using the keywords "glaucoma", "microinvasive glaucoma surgery", "complications", "goniotomy", and "trabeculotomy". Publications discussing ab-interno trabeculotomy procedures were selected; furthermore, the relevant references in these articles were gathered and the search was updated during the article preparation. Since gonioscopy-assisted transluminal trabeculotomy was first introduced in 2014, we had no time restriction. Results: Ab-interno trabeculotomy procedures, as a type of minimally invasive glaucoma surgeries, facilitate the natural trabecular outflow and lower the intraocular pressure (IOP) while preserving the conjunctiva for possible future glaucoma surgeries. It can be done alone or in combination with cataract surgery and effectively lowers the IOP and the number of antiglaucoma medications in various forms of glaucoma. Conclusion: By appropriate patient selection, ab-interno trabeculotomy could be selected as a safe and effective procedure in the management of various forms of glaucoma either as an isolated procedure or in combination with cataract extraction.

Intraocular Pressure Changes in the Contralateral Eye After Glaucoma Surgery.

PRCIS: Glaucoma surgery in 1 eye can result in significant intraocular pressure (IOP) elevation in the fellow eye in a significant percentage of subjects. This effect is more pronounced following glaucoma drainage device implantation and in subjects developing postoperative hypotony in the first eye. PURPOSE: The aim was to investigate the course and magnitude of IOP changes in contralateral eyes following glaucoma surgery. PATIENTS AND METHODS: We studied 131 glaucoma patients undergoing surgery. IOP changes in fellow eyes and the number of glaucoma medications were recorded for 6 months. Both normal and glaucomatous fellow eyes were included. Patients on preoperative acetazolamide were analyzed separately. IOP change ≥4 mm Hg or 20% increase from baseline values was considered significant. RESULTS: Baseline IOP in fellow eyes was 13.1±3.3 mm Hg which increased significantly at all-time points with a peak at 1 week (mean increase: 3.1±3.2 mm Hg) gradually decreasing up to 6 months (mean increase 0.9±2.1 mm Hg). The number of fellow eyes with clinically significant IOP elevation at 1 day, 1 week, and 1, 3. and 6 months was 47, 76, 47, 31, and 37 showing mean IOP rise of 4.5±2.3 (38.5%), 5.4±1.8 (48.5%), 4.8±1.6 (44.2%), 3.7±1.3 (36.5%), and 3.2±1.3 (32.6%) mm Hg, respectively. Medications were added to 18 fellow eyes (including 10 initially "normal" eyes) while 7 other fellow eyes required surgery.Significant IOP elevation in fellow eyes was associated with tube shunt surgery (P<0.008 at all-time points), a diagnosis of glaucoma following cataract surgery, IOP ≤5 mm Hg on the first postoperative day (P=0.002) and use of preoperative acetazolamide. CONCLUSION: Glaucoma surgery was associated with IOP elevation in fellow eyes in a significant number of subjects and suggests that IOP in the unoperated eye should also be checked at postoperative visits.

Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases.

PURPOSE: The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). METHODS: The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. RESULTS: Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. CONCLUSIONS: These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.

A new glaucoma drainage implant with the use of Polytetrafluoroethylene (PTFE). A pilot study.

Purpose: To investigate the implantation of Polytetrafluoroethylene (PTFE) as a glaucoma drainage device. Methods: This study has been done in two steps. First, the constructed implants have been used in 4 rabbits and the histopathologic response was evaluated. In the second step, the implants were used in the 6 eyes of 6 patients with end-stage glaucoma with uncontrolled IOP and poor visual acuity. The tube was made of two-layer of PTFE membrane measuring 8 * 6 mm with a thickness of 1.8 mm and a silicone tube. The rabbits and the human eyes underwent surgical implantation of the tube in the anterior chamber. The histopathologic evaluation was done using H&E staining. Visual acuity, intraocular pressure and the number of glaucoma medications were assessed before and after the surgery. Results: In the histopathologic evaluation, subconjunctival polarizing fibers of a synthetic mesh infiltrated by fibrovascular septa was seen. A granulomatous inflammatory reaction composed of histiocytes, lymphocytes, and multinucleated giant cells were seen around and between the synthetic bundles. The average age of patients was 63 ± 5.5 years. The mean IOP reached from 36.6 ± 5.7 mmHg at baseline to 16.2 ± 8.9 mmHg at the final follow-up. Patients were followed for an average of 6.6 ± 4.5 months. One patient found hypotony refractory to medical and surgical treatment, which led to implant removal. One patient had uncontrolled IOP and finally led to phthisis bulbi following slow CPC. The remaining four eyes did well during the follow-up. Conclusion: The use of PTFE as a new polymer in tube shunt construction was reported. Larger studies, modification of the PTFE membranes like changing the porosity amount, and size of PTFE membranes might result in different conclusions.

The Role of Trace Elements in Pseudoexfoliation Syndrome: A Cross-sectional Study.

PURPOSE: Pseudoexfoliation syndrome (PXF) is an age-related condition, characterized by deposition of whitish flake-shaped materials in the anterior segment of the eye. Although it occurs all over the world, a considerable racial variation exists. According to the high frequency of PXF in Iran and the importance of prevention and early treatment, we evaluated the plasma level of iron, zinc, copper, and magnesium in patients with PXF. METHODS: In this study, 83 individuals were enrolled; 40 patients with cataract and PXF as the case group and 43 age- and sex-matched individuals with cataract but without PXF as the control group. The serum levels of the mentioned microelements were compared in two groups. RESULTS: In the case group, 25 (62.5%) male and 15 (37.5%) female subjects participated. In the control group, the corresponding figures were 22 (51.2%) and 21 (48.8%), respectively. The mean age of the case group was 66.07 ± 9.46 and that for the control group was 66.88 ± 8.04 years. Regarding the case group, the serum levels of iron, zinc, copper, and magnesium were 60.58 ± 21.04, 84.7 ± 14.37, 120.23 ± 14.43, and 2.11 ± 0.23, respectively. These serum levels in the control group were 89.07 ± 26.06, 97.51 ± 17.42, 123.33 ± 19.01, and 2.14 ± 0.16. The serum levels of iron and zinc were significantly lower in the case group than the control group (P < 0.0001); however, such a difference was not observed in terms of copper and magnesium serum levels. CONCLUSION: Our study demonstrated that the serum iron and zinc levels were lower in PXF patients. Nutritional deficiency may be a cause of zonular weakness in these patients. Heme is a cofactor for the enzyme which contributes to the biosynthesis of fibrillin, the major protein in zonular fibers. Therefore, iron can play a substantial role in the biosynthesis of the fibrils and also in the zonular stability.

Liver Transplant for Metastatic Neuroendocrine Tumors: A Single-Center Report of 15 Cases.

OBJECTIVES: Liver transplant has been shown to be a good treatment option for patients with nonresectable tumors that are limited to liver and that do notrespond to medicaltreatment. In this study, our aim was to share our experience in management of patients with neuroendocrine tumors and liver metastasis by liver transplant with and without more extensive surgical interventions. MATERIALS AND METHODS: We performed a 6-year (2011- 2017) retrospective study of data from the Namazi Hospital Transplant Research Center. Inclusion and exclusion criteria were determined based on pretransplant policy in our center. Our study included 15 patients with mean age of 33.3 years. RESULTS: Of the 15 patients included, 53.3% (n = 8) had liver transplant alone, 26.6% (n = 4) had multiorgan transplant, 6.66% (n = 1) underwentWhipple procedure and liver transplant, and 6.66% (n = 1) had segmental ileal resection and liver transplant. Six early mortalities occurred during the posttransplant hospital stay, and 2 patients with multiorgan transplant died in the followup period. In addition, 1 patient needed retransplant during follow-up due to chronic rejection. CONCLUSIONS: In patients with neuroendocrine tumors, the therapeutic approach to the liver metastasis and the prognosis can be determined based on the natural history of the disease, severity and progression of symptoms,tumor biology, location, and differentiation. Early diagnosis and management are needed to allow less invasive treatment protocols, which could result in more favorable outcomes.

EVALUATION OF THE EFFECT OF TOPICAL INTERFERON α2b AS A COMPLEMENTARY TREATMENT OF MACULAR EDEMA OF PATIENTS WITH DIABETIC RETINOPATHY: A Double-Blind Placebo-Controlled Randomized Clinical Trial Study.

PURPOSE: The objective of this study is to evaluate the effect of the topical interferon α2b (IFNα2b) as an adjunctive therapy in the treatment of diabetic macular edema. METHOD: This was a randomized controlled clinical trial performed on patients with diabetic macular edema. Fifty eyes of 50 patients (one eye/patient) who were receiving treatment for diabetic macular edema were randomly assigned to get topical IFNα2b 1 MU/mL or artificial tear eye drop as an adjunctive therapy. The primary measure outcomes were best-corrected visual acuity and central macular thickness; the secondary goals were to assess the effect of topical IFNα2b on the intraocular pressure and its potential side effects. RESULTS: Baseline demographic data of the two groups were similar. The improvement in visual acuity of patients on IFN was more than the patients on artificial tear by the end of the fourth week (6.85 and 1.45 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.001) and the eighth week (6.75 and 1.05 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.005). The central macular thickness was also decreased correspondingly by the end of fourth week (53.1 ± 153 µm for patients on IFN and 26.6 ± 119.1 µm for patients on artificial tear, P = 0.497) and eighth week (27.9 ± 67.7 for patients on IFN and 29.2 ± 98 µm for patients on artificial tear, P = 0.957), but it was not statistically significant. Intraocular pressure was decreased on the fourth week in IFN group for 1.7 mmHg ±3 and increased for 0.1 mmHg ±2.3 in the artificial tear group (P = 0.018). No significant side effect was detected with topical IFN drop. CONCLUSION: This study evaluated the short-term effects of topical IFNα2b 1 MU/mL. The drug was well tolerated and may have an effect on improvement of best-corrected visual acuity in patients with diabetic macular edema. It also had an intraocular pressure lowering effect on the studied eyes. However, further studies are needed to confirm this finding.

Intralenticular Cilia Following Penetrating Ocular Trauma: A Case Report.

Penetrating ocular trauma is one of the most important causes of vision loss, especially in men, and can be associated with intraocular foreign bodies. The incidence of intraocular cilia after trauma is very low. Here we report the case of a 24-year-old man who visited Poostchi Ophthalmology Clinic (Shiraz, Iran) due to a gradual vision loss in his left eye over the past 2 months. The probable cause was a foreign object (metal splinter) in the eye as a result of hammering metal on metal. An examination revealed the site of a 2-mm sealed corneal laceration, localized central cataract with intralenticular cilia, and moderate anterior reaction. The patient underwent foreign body removal, lensectomy, and posterior chamber intraocular lens implantation. One day after the operation, the visual acuity of the patient was 20/20. The intraocular cilia may have various clinical presentations; however, there is no report of a case with cilium embedded in the lens without any sight-threatening complications other than localized cataract and a moderate inflammatory reaction. Timely management and operation allow such patients to maintain a good vision.

Candida albicans endophthalmitis following penetrating keratoplasty: A case report.

Endophthalmitis is one of the most serious complications of intraocular surgeries, and Candida albicans constitutes the majority of cases of post penetrating keratoplasty (PK) endophthalmitis. The presenting case is a 21-year-old woman with known case of advanced keratoconus and vernal keratoconjunctivitis who underwent PK, and developed recalcitrant anterior uveitis and subsequent whitish lesion on the superonasal of the lens. She was on topical steroids with possible impression of Uretts Zavalia syndrome versus phacoantigenic uveitis following traumatic cataract up to the 50th day of post operation that manifested symptoms of frank endophthalmitis; and underwent deep vitrectomy, lensectomy, localized iridectomy and irrigation with diluted Imipenem and Amphotericin-B. Microbiologic study of a vitreous sample revealed growth of Candida albicans, however optisol culture was negative and donor rim was not evaluated. One week later, intravitreal Amphotericin-B was administered. The patient remained aphakic with clear graft in the 6th month follow up. Due to great correlation of positive donor rim culture with fungal endophthalmitis and the devastating effect of delayed diagnosis, routine donor rim culture is recommended, to aid us in earlier diagnosis in the presence of nonspecific early signs of fungal endophthalmitis.

Modified Primary Prophylaxis in Previously Untreated Patients With Severe Hemophilia A in Iran.

BACKGROUND: Recently the low-dose tailoring method of primary prophylaxis has been introduced for previously untreated patients with hemophilia A. OBJECTIVE: To evaluate the efficacy and safety of low-dose tailoring method of primary prophylaxis in previously untreated patients with severe hemophilia A. MATERIALS AND METHODS: In this pre-post interventional study, 33 patients with severe hemophilia A who were previously untreated and affiliated to universities in the capital city and southern Iran were evaluated during 2014 to 2015. Modified primary continuous prophylaxis was used for patients with age below 3 years old, after first and before the second episodes of obvious clinical bleeding in large joints or large soft tissue hematoma or large amount of bleeding. Prophylaxis was started by 25 IU/kg once per week and increased to twice or 3 times a week according to defined bleeding events. RESULTS: The median age at diagnosis and age of starting prophylaxis were: 4 months (at birth, 22 mo) and 12 months (1 to 35 mo), respectively. Mean annual bleeding rate of patients after prophylaxis was 1.08±2.21 episodes per year. None of the patients had inhibitors before therapy. Inhibitor was present in 5 patients (15.1%) after prophylaxis. CONCLUSIONS: It seems that modified primary continuous prophylaxis has been successful in reducing bleeding episodes in children with severe hemophilia A and in the texture of lower cost it can improve quality of life of these patients, especially in developing countries where financial resources are limited.

Phenotype Report on Patients with Congenital Factor V Deficiency in Southern Iran: Recent Ten Years' Experience.

This study aimed to investigate clinical symptoms in patients with congenital factor V (FV) deficiency and the relationship between phenotype and factor activity level. Thirteen patients with congenital FV deficiency were investigated and the factor activity level and first clinical presentations were studied for each patient. The most common first signs and symptoms were post-surgery, post-partum, post-circumcision, and post-traumatic bleeding (30.76%), followed by easy bruising in 23.10% of the patients. The median age at the onset of clinical signs was 18 (range: 1-53) years. Patients were categorized into two groups of major and minor bleeding based on their first clinical bleeding symptoms. There was not a significant difference between the two groups with regard to factor activity level, age at diagnosis, prothrombin time, partial thromboplastin time, and international normalized ratio (p>0.05). There is a discrepancy between plasma FV activity level and the severity of clinical presentations.